State of Black mental health in Los Angeles

Psychiatric care is inhibited by inherent bias

Gregg Reese OW Contributor |
5/9/2019, midnight

Lekeisha A. Sumner, a clinical psychologist in the Psychiatry Department at UCLA agrees. Her clientele is likely more diverse then one found in South Los Angeles, but comes to the same conclusions: “Many clients of color are grappling with issues and stressors associated with “shifting” as it relates to assimilation, acculturation, navigating complex work and relational dynamics along with family and partner demands.” She notes, reinforcing the observation that “fitting in” to a racially inhospitable environment is in itself a considerable challenge. Within the CMHP staff no psychiatrists (who are medical doctors) are available to write prescriptions, but 25 percent reportedly utilize psychotropic medication to address their issues. This doesn’t include those who “self-medicate,” using street intoxicants to address their psychological issues and get through their day.

A cookie cutter approach

Pathology - The study of the nature and origin of disease. —Defined as “that branch of medicine which treats of the essential nature of disease.” —From the Greek words “pathos” meaning “disease” and “logos"meaning “a treatise” = a treatise of disease.

Coincidentally, the day before my interview Dr. Cox had a session with a man who related his past history within the psychiatric/penal system. During his stay in an unnamed facility he described as among “the most restricted” in the system, the professionals assessing him deemed him as having “the mind of a 5-year-old.” The fact that this man, a poly substance abuser from the Deep South with a primary school education, could articulately recount this episode with such clarity has Dr. Cox convinced he is one of the countless unfortunates rubber stamped through the system and “over-pathologized.” She, along with scores of minority health professionals working in psychology are adamant that well-meaning clinicians are hamstrung by the tendency to assess their clientele through the prism of westernized notions of normalcy.

Her colleague over at UCLA, psychologist Sumner, concurs. “Too often in the research literature, ethnic communities are grouped together using White Americans as a benchmark,” she notes. “This is a grave mistake as all groups—including Whites—exhibit variations within the group, especially as it relates to socioeconomic status and gender.”

This rampant bias means that patients are evaluated (or judged) by standards inherently different from their culture, experiences, and society they are accustomed to. Disregarding the nuances of cultural differences is an impediment to effective therapy.

Cultural insensitivity

“Bias is inherent in models of diagnosis that were founded on European ways of being, believing and doing---Not every problem is rooted in culture, but culture provides context about how people see and experience the world and how they perceive wellness and illness.” —Ruth C. White

Moving west to USC, Ruth White, an associate clinical professor, is in agreement with Cox, citing a lack of “cultural competence,” as a barrier for some therapists to fully relate to their patients. “Some mental health professionals can view some ethnic communities through a lens of pathology,” she believes, “instead of through a lens of resilience, if they are not trained to take culture into account.” She takes pains to stress this may not be the fault of individual clinical staff.